WOCN Position on Popping Blisters
The Wound, Ostomy, and Continence Nurses Society (WOCN) does not have a specific published position statement on blister management ("popping blisters"), as their guidelines focus on pressure injuries, arterial wounds, and diabetic/neuropathic wounds rather than acute blister care. 1, 2, 3
Guideline-Based Recommendations from Other Authoritative Sources
Since WOCN has not published specific guidance on this topic, the following represents the consensus from major dermatology and wound care organizations:
Primary Recommendation: Drain But Preserve the Roof
The British Association of Dermatologists recommends puncturing large or functionally problematic blisters with a sterile needle at the base to facilitate gravity drainage, while leaving the blister roof intact as a natural biological dressing. 4, 5
- The blister roof acts as a protective barrier that reduces infection risk and promotes re-epithelialization 4, 5
- Apply gentle pressure with sterile gauze to absorb fluid after puncturing 5
- This approach is specifically endorsed for bullous pemphigoid and other blistering conditions 4
When to Leave Blisters Intact
The American Heart Association (2015 Guidelines) recommends leaving burn blisters intact and loosely covering them with a sterile dressing, as this improves healing and reduces pain. 4
- Small, asymptomatic blisters should generally be left undisturbed 4
- Intact blisters provide optimal wound healing conditions 4
When Drainage is Indicated
For epidermolysis bullosa specifically, the British Journal of Dermatology strongly recommends lancing and draining blisters as soon as possible to reduce pain and blister size, with review for new blisters at each diaper change. 4
- Large blisters or those on weight-bearing surfaces (like the sole of the foot) should be drained 4
- Blisters interfering with function warrant drainage 4, 5
- The technique involves puncturing at the base with the needle bevel up, selecting a site that allows gravity drainage 5, 6
Post-Drainage Management
After draining, apply petrolatum-based antibiotic ointment and cover with a low-adhesion, non-adherent dressing secured with soft elasticated viscose. 4, 5
- Petrolatum-based products support barrier function and reduce transcutaneous water loss 5
- Antibiotic ointment accelerates healing and eliminates bacterial contamination within 16-24 hours 5
- Change dressings using aseptic technique 5
Critical Pitfall to Avoid
Never remove the blister roof entirely—this increases infection risk and delays healing. 4, 5, 6
- The overlying skin serves as a biological cover and should be preserved 4, 7
- Removing the roof exposes raw dermis to contamination and increases pain 4
Monitoring Requirements
Perform daily assessment for signs of infection including increased erythema, purulent discharge, fever, or worsening pain. 5